Liu Qing-Yu, Lai Dong-Ming, Gao Ming, Wan Yun-Le, Lin Xiao-Feng, Li Hai-Gang, Liang Bi-Ling
Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Xi Road, Guangzhou, 510120, Guangdong Province, China,
Abdom Imaging. 2013 Oct;38(5):1061-70. doi: 10.1007/s00261-012-9942-y.
To retrospectively review the MRI imaging features of adult choledochal cysts associated with biliary malignancy.
Ten out of 72 cases of adult choledochal cysts were found to be associated with biliary malignancy between January 1, 2003 and April 1, 2011 in our hospital database. The following MRI findings of these ten patients were retrospectively reviewed: the type of choledochal cysts, the presence of anomalous union of the pancreaticobiliary duct (AUPBD), manifestations of biliary malignancy, and concomitant findings.
Among the ten patients, there were five type I and five type IVA choledochal cysts. AUPBD was noted in four cases. The biliary malignancy was diagnosed as cholangiocarcinoma in seven cases (70.0%) and as gallbladder cancer in three cases. Cholangiocarcinoma manifested with irregularly thickened cyst wall (n = 2), mass with irregularly thickened cyst wall (n = 4), or multiple papillary nodules without thickened cyst wall (n = 1). Most of them showed mark enhancement (n = 4) after contrast administration. Gallbladder cancer appeared as mass with irregular thickening of the gallbladder wall with inhomogeneous enhancement. Concomitant findings included liver invasion or metastases in five cases, lymph node metastases in two cases, cholangitis and/or hepatic abscess in two cases, biliary stones in three cases. The type of choledochal cysts and the extent of malignant tumor invasion revealed by MRI were consistent with the surgical findings.
Most malignancies associated with choledochal cysts are cholangiocarcinoma and gallbladder cancer. MRI is a reliable method for the detection of choledochal cysts with biliary malignant changes. MR features such as irregular thickening of the gallbladder wall or cyst wall, mass or papillary nodules are suggestive of biliary malignant changes.
回顾性分析成人胆总管囊肿合并胆道恶性肿瘤的MRI影像特征。
在我院2003年1月1日至2011年4月1日的数据库中，72例成人胆总管囊肿患者中有10例合并胆道恶性肿瘤。回顾性分析这10例患者的以下MRI表现：胆总管囊肿类型、胰胆管合流异常（AUPBD）情况、胆道恶性肿瘤表现及伴随表现。
10例患者中，5例为I型胆总管囊肿，5例为IVA型胆总管囊肿。4例发现有AUPBD。7例（70.0%）胆道恶性肿瘤诊断为胆管癌，3例为胆囊癌。胆管癌表现为囊肿壁不规则增厚（2例）、伴有囊肿壁不规则增厚的肿块（4例）或无囊肿壁增厚的多个乳头状结节（1例）。多数在增强扫描后呈明显强化（4例）。胆囊癌表现为胆囊壁不规则增厚伴不均匀强化的肿块。伴随表现包括5例肝脏侵犯或转移、2例淋巴结转移、2例胆管炎和/或肝脓肿、3例胆结石。MRI显示的胆总管囊肿类型及恶性肿瘤侵犯范围与手术所见一致。
胆总管囊肿合并的恶性肿瘤多数为胆管癌和胆囊癌。MRI是检测合并胆道恶性病变的胆总管囊肿的可靠方法。胆囊壁或囊肿壁不规则增厚、肿块或乳头状结节等MR特征提示胆道恶性病变。
